Obesit\uc3\ua0 ed ipertensione

none3noneFALOIA E; GIACCHETTI G; MANTERO F.Faloia, E; Giacchetti, G; Mantero, Franc

Corticotropin-releasing hormone and desmopressin tests in the differential diagnosis between Cushing's disease and Pseudo-Cushing state: a comparative study.

Abstract BACKGROUND: We recently proposed a new and effective way of interpreting human corticotrophin-releasing hormone (hCRH) and desmopressin (DDAVP) tests, for the differential diagnosis between Cushing's disease (CD) and pseudo-Cushing state (PC), based on the simultaneous analysis of ACTH and cortisol. OBJECTIVE: The study had the aims of comparing the diagnostic performance of the two tests and determining whether carrying out both tests was more beneficial than carrying out only one. PATIENTS AND MEASUREMENTS: We studied 30 CD, 18 PC and 12 control (CT) subjects: in these patients, hCRH test, DDAVP test, 24-h urinary free cortisol, serum cortisol after overnight 1-mg dexamethasone suppression test and serum cortisol circadian rhythm were performed. RESULTS: The hCRH test and the DDAVP test showed an identical and excellent diagnostic performance (sensitivity 96·6% and specificity 100% for both tests); moreover, the hCRH and DDAVP tests showed almost perfect diagnostic agreement (κ = 0·93; P < 0·05) with a significantly higher number of concordant diagnoses (58 cases of 60) than those resulting from all other possible combinations among the studied tests. Interestingly, there were no subjects in whom both hCRH and DDAVP tests gave a simultaneous misdiagnosis. CONCLUSIONS: Our study indicates that the hCRH and DDAVP tests have similar diagnostic performance and present excellent agreement, without giving simultaneous misdiagnosis in any subject. Because of these characteristics, the use of both tests offers the physician a valuable tool for those cases of hypercortisolism which are difficult to interpret

Protective effect of leg fat against cardiovascular risk factors in obese premenopausal women

BACKGROUND AND AIMS: While the relationship between abdominal fat and cardiovascular risk (CVR) factors is well established, the possible protective role of peripheral fat against these factors has received less attention, particularly in severely obese individuals. The principal aim of this study was to analyse the relationship, if any, among amount of leg fat, CVR factors and body mass index (BMI) in obese premenopausal women. METHODS AND RESULTS: Subjects were 80 obese premenopausal women. Body composition was measured by dual energy X-ray absorptiometry (DEXA); CVR factors (blood pressure, plasma lipids, glucose) were determined and anthropometric measurements (waist and hip circumferences) taken. In severely obese women (BMI>40 kg/m(2)) leg fat correlated negatively with CVR factors, whereas metabolic parameters were not significantly different from those of subjects with BMI<40 kg/m(2). CONCLUSIONS: Leg fat seems to play a protective role against CVR factors in severely obese premenopausal women

Adrenal incidentaloma

Incidentally discovered adrenal masses, or adrenal incidentalomas, have become a common clinical problem owing to wide application of radiologic imaging techniques. This definition encompasses a heterogeneous spectrum of pathologic entities, including primary adrenocortical and medullary tumors, benign or malignant lesions, hormonally active or inactive lesions, metastases, and infections. Once an adrenal mass is detected, the clinician needs to address two crucial questions: is the mass malignant, and is it hormonally active? This article provides an overview of the diagnostic clinical approach and management of the adrenal incidentaloma. Mass size is the most reliable variable to distinguish benign and malignant adrenal masses. Adrenalectomy should be recommended for masses greater than 4.0 cm because of the increased risk of malignancy. Adrenal scintigraphy has proved useful in discriminating between benign and malignant lesions. Finally, fine-needle aspiration biopsy is an important tool in the evaluation of oncological patients and it may be useful in establishing the presence of metastatic disease. The majority of adrenal incidentalomas are non-hypersecretory cortical adenomas but an endocrine evaluation can lead to the identification of a significant number of cases with subclinical Cushing's syndrome (5-15%), pheochromocytoma (1.5-13%) and aldosteronoma (0-7%). The first step of hormonal screening should include an overnight low dose dexamethasone suppression test, the measure of urinary catecholamines or metanephrines, serum potassium and, in hypertensive patients, upright plasma aldosterone/plasma renin activity ratio. Dehydroepiandrosterone sulfate measurement may show evidence of adrenal androgen excess

Desmopressin test in the differential diagnosis of Pseudo-Cushing state from Cushing’s disease.

Context: The desmopressin (DDAVP) test has been proposed to discriminate Cushing's disease (CD) from pseudo-Cushing states (PC); however, current information on its value is scarce and contradictory. Objective: The aim of the study was to assess the ability of the DDAVP test in distinguishing between these conditions, with emphasis on subjects with mild hypercortisolism. Design and setting: We conducted a retrospective/prospective study at the Division of Endocrinology, Polytechnic University of Marche, Ancona, Italy. Patients: The study included 52 subjects with CD, 28 with PC, and 31 control subjects (CT). Intervention(s): We performed the DDAVP test and standard diagnostic procedures for the diagnosis of Cushing's syndrome. Main outcome measure(s): The diagnosis/exclusion of CD was measured. Results: Interpretation of the DDAVP test based on percentage and absolute increment of cortisol and ACTH did not afford acceptable values of both sensitivity (SE) and specificity (SP). CD diagnosis based on simultaneous positivity for basal serum cortisol greater than 331 nmol/liter and absolute ACTH increment greater than 4 pmol/liter and its exclusion in subjects negative for one or both measures yielded an SE of 90.3% and an SP of 91.5%. The approach was also highly effective in distinguishing PC from: 1) CD with moderate values of urinary free cortisol (SE, 86.9%; SP, 92.8%); 2) CD with moderate values of serum cortisol after dexamethasone suppression (SE, 86.6%; SP, 92.8%); and 3) CD with moderate values of midnight serum cortisol (SE, 100%; SP, 92.8%). Conclusions: Interpretation of the DDAVP test through a combination of parameters allowed effective discrimination of CD from PC, even in subjects with mild hypercortisolism